A USAID program supporting 1,900 health facilities and credited with halving maternal and neonatal mortality in target regions was terminated. Midwives and community health workers trained under the program report sharp declines in referrals and facility deliveries, eroding the progress achieved over several years.

Date: 10/25

Region: Africa

Country: Madagascar

Topic: Health

Policy Lens: Global Health Security

Additional Context: From 2018-2025, Management Sciences for Health (MSH) implemented the USAID Accessible Continuum of Care and Essential Services Sustained (ACCESS) program. The program operated in 78 districts across 14 regions and reached approximately 16 million people. ACCESS aimed to strengthen local health systems and promote lasting healthy behaviors. Activities spanned maternal and child health, malaria prevention/detection/treatment, reproductive health and family planning, malnutrition prevention and care, and water, hygiene, and sanitation. The program also provided comprehensive support to the Ministry of Health during major public health emergencies, including the measles outbreak, poliovirus resurgence, and COVID-19. The program was terminated.

Source: MSH